Dry Sockets: Causes / Risk Factors.
Risk factors for dry sockets (alveolar osteitis) - Part II.
This page discusses the following causes and risk factors for dry sockets: 1) Smoking. 2) Taking oral contraceptives. 3) The presence of oral bacteria. 4) The age of the dental patient. And how dry socket incidence varies according to tooth location.
Additional causes are discussed here: Dry socket causes/risk factors.- Part I
A) Patients who smoke are more likely to get a dry socket.
Some research studies have found that people who smoke are more than four times as likely to develop a dry socket as compared to those who don't.
How does smoking cause dry sockets?
A number of theories have been put forward as an explanation as to why the association between dry sockets and smoking exists. Some of them are:
- The carbon monoxide that enters a person's bloodstream when they smoke limits the amount of oxygen that can be carried to, and thus is available to, the extraction site's healing tissues.
- The sucking action created when a person smokes may draw out or otherwise dislodge the blood clot that has formed in the tooth socket.
- Nicotine may create systemic effects that interfere with the normal healing process.
- At a local level, tobacco smoke may damage or be toxic to tissue cells.
What precautions should you take if you do smoke?
As difficult as this may be, if you do smoke (and can't totally quit the habit) you may be able to reduce your potential for a dry socket by not smoking the day of your surgery and then for at least several days afterward. (Symptoms of dry socket formation typically appear within 5 to 6 days after an extraction. However, the healing process will progress as quickly and uneventfully as possible if you don't smoke during the entire two weeks or so while it is taking place.)
B) Women who take oral contraceptives may be at greater risk for dry sockets.
Women who take birth control pills may be at greater risk for developing a dry socket. However, this effect may have been more evident in previous decades when oral contraceptives contained a larger dosing of estrogen.
Estrogen may be the risk factor.
- The relationship between dry sockets and oral contraceptives may be due to an effect where estrogen activates fibrinolysis, which in turn leads to blood clot disintegration.
- This effect may explain why women as a group are 20% more likely to experience dry sockets than men.
If you're on birth control pills, timing your extraction may help to prevent a dry socket.
Women who take birth control pills may be able to minimize their risk for a dry socket by scheduling their tooth extraction during those days when the estrogen dosing of their contraceptive regimen is at its lowest.
Ask your dentist for details. With some oral contraceptive products this will be those days (days 23 to 28 of your tablet cycle) when no pill, or else a placebo pill, is scheduled to be taken.
C) Bacteria may play a role in dry socket formation.
Some dental research supports a view that oral bacteria may play a role in the formation of dry sockets. This theory, however, is not universally accepted by the dental community as a whole.
Evidence that supports this theory includes the following factors, each of which seem to correlate with a greater risk for having a dry socket form.
- A high bacterial count in the region of the extraction site (existing either before or after the extraction).
- An active infection in the gum tissue surrounding their tooth before it's extracted. (A condition termed pericoronitis.)
- People who, overall, have generally poor oral hygiene.
Additionally, some studies have suggested that the following steps can help to prevent dry sockets:
- Having a patient rinse with an antibacterial mouthwash (chlorhexidine) before their tooth extraction.
- Placing an antibiotic-impregnated packing into the tooth socket immediately following an extraction.
Dry sockets are typically not treated with antibiotics.
Despite whatever role oral bacteria may play in their initial formation, most protocols for treating dry sockets do not include the use of antibiotics.
D) Patient age as a risk factor for dry sockets.
Some studies have suggested that there is a correlation between the age of a dental patient and their potential for the formation of a dry socket.
And even though this theory hasn't been confirmed by all studies, the general rule of thumb is that comparatively younger patients are at less risk for having dry sockets than comparative older patients.
What kind of numbers may be involved?
One study found that dental patients in the age group 15 to 19 years developed dry sockets at a rate of about 3% whereas patients in the age group 30 to 34 experienced them at 3 times this rate. (This is one of the reasons why a dentist might suggest to a patient that they should have their wisdom teeth removed during the age window of "late teens to early 20's." )
E) Tooth location: Another dry socket risk.
The location of the tooth being extracted appears to correlate with a patient's risk for developing a dry socket.
In regards to location, here's what you can expect.
- There is generally a higher incidence of dry socket formation when a lower tooth is extracted, as opposed to an upper one.
- Having a posterior tooth pulled (especially a molar) typically poses a greater risk than a front tooth.
- The greatest risk for dry socket formation appears to be associated with having a lower wisdom tooth, especially an impacted one, removed. (The situation shown in the picture to the right.)
